Drug utilization study of antihypertensive drugs used in the treatment of second and third trimester of pregnancy in tertiary care hospital

Background: Hypertensive disorders are major cause of the perinatal and maternal mortality and morbidity worldwide. Aim of study was to evaluate current trend of antihypertensive drugs and to assess frequency and distribution of antihypertensive drugs in pregnancy.Methods: A retrospective observational study was conducted in a tertiary care hospital for period of six months in collaboration with department of obstetrics and gynaecology. Patients data recorded in case report form and analysed to study prescription pattern and related information.Results: Total of 104 cases were enrolled in this study. Prescribed antihypertensive drugs in pregnancy were Labetalol, Nifedipine, MgSO4 and furosemide. Most commonly prescribed drug was labetalol. In this study, Gestational hypertension was most common diagnosis in hypertensive disorder. Majority of drug prescribed from category C and A. In present study, Single drug therapy was most commonly prescribed for hypertension in pregnancy was 64.42% whereas multiple drug therapy was 35.57%. Most common maternal complication was anaemia i.e. 54.05% followed by placental abruption in 24.3%. Neonatal outcome was low birth weight i.e.36% followed by preterm birth i.e.24%.Conclusions: Labetalol found to be most common prescribed drug. Single drug therapy prescription was high as compared to multiple drug therapy prescription in hypertensive disorders in pregnancy. Gestational hypertension was most common cause of hypertensive disorder. Anaemia was found to be most common maternal complication encountered in hypertensive disorders in pregnancy. Most common adverse neonatal outcome was low birth weight.

Markers of alcohol use disorder-its impact on the comorbid diseases and outcomes in patients admitted into tertiary care hospital

Background: The treatment for medical complications of alcohol misuse has been restricted by primary care providers recently by referring patients to specialized alcohol treatment. Aim: The proposed study aimed to identify the patients with alcohol use disorder and estimation of selected biomarkers like Gamma-glutamyl transferase (GGT) and Carbohydrate-deficient transferrin (CDT) in selected patients with objective of comparing its impact on co-morbid condition, assessment of its outcomes in selected patients. Materials and Methods: This was a multi-arm observational, interventional study, in which patients of alcohol use disorder were selected as the study population. This study was conducted in Department of General Medicine, Mahatma Gandhi Memorial Hospital, Warangal, Telangana. Results: In alcoholic patients, age in years was 55.1±8.5 and in non-alcoholic patients’ age in years was 58.4±11.6, in alcoholic patients males were 50% and females were 5% and in non-alcoholic patients, males were 40% and females were 4%. In hepatic encephalopathetic alcoholic patients 40% was seen and in hepatic encephalopathetic non-alcoholic patients, 36% was seen. In the alcoholic patients, Ascitis was observed in 49% and 48% of the non-alcoholic patients. 48% of the alcoholic patients had upper gastro-intestinal bleeding and it was 3% in non-alcoholic patients. Conclusion: The heavy use of alcohol prevalence was very high and was associated with poor prognosis in hospitalised patients which further increased the risk of infection and death.

Maculopapular rash presentation of febrile illness in an adult with Varicella zoster virus infection.

Varicella zoster usually manifests as maculopapular rash (MPR), which later progresses to vesicle. It can also manifest as MPR without progression to the vesicle stage. This atypical manifestation is more common in adults and immunocompromised patients. A 30‑year‑old female presented with high‑grade fever and rash over face and body for 5 days. She was diagnosed to have Varicella zoster virus (VZV) infection by positive VZV immunoglobulin M enzyme‑linked immunosorbent assay and polymerase chain reaction. We present this case to increase awareness among clinicians on the atypical manifestations of VZV and prevent complications by early diagnosis.

Modification of mercury-induced biochemical alterations by Triticum Aestivum Linn in rats.

The present investigation has been undertaken to evaluate role of Wheat grass extract in modifying mercuryinduced biochemical alterations in albino rats. Mercuric chloride 5 mg/kg body weight i.p. was given on 11, 13 & 15th day of the experiment. Wheat grass extract (400 mg/kg) and Quercetin (10 mg/kg) were administered 10 days before mercuric chloride administration and continued up to 30 days after mercuric chloride administration. The animals were sacrificed on 1, 15 and 30 days, the activity of serum alkaline and acid phosphatase and the iron, calcium, BUN, creatinine, SGPT, SGOT, total bilirubin, total protein levels were measured. Tissue lipid peroxidation content, glutathione (GSH) level, anti-oxidant enzymes- CAT and GR were measured. Hematological indices were also estimated. Mercury intoxication causes significant increase (P<0.001) in calcium level, acid phosphatase, BUN, creatinine, SGOT, SGPT, total bilirubin, lipid peroxidation content and significant decrease in iron level, alkaline phosphatase, total protein, and CAT, GR and glutathione level. Wheat grass extract pre- and post-treatment ameliorated mercury-induced alterations in terms of biochemical and hematological parameters. Concomitant treatment of Wheatgrass extract with Mercury showed prominent recovery and normal architecture with mild residual degeneration in the tissues. Thus from present investigation, it can be concluded that Wheat grass extract pre- and post-treatment with HgCl2 significantly modulate or modify mercury-induced biochemical alteration in albino rats.

Neuroactive steroids and their role in epilepsy.

Neuroactive steroids are the certain steroids that alter neuronal excitability via the cell surface through interaction with certain neurotransmitter receptors. Neuroactive steroids regulate physiological functions of the central nervous system and have possible therapeutic potential in neurological diseases. They have been shown to affect neuronal excitability via their interaction with the ligand-gated ion channel family, such as the GABAA receptor by acting genomically as well as nongenomically. Positive modulators of GABAA receptor have anticonvulsant action as they enhance GABAergic transmission thereby increasing the seizure threshold. By virtue of these properties, neurosteroids appear to be relevant to pathophysiology and pharmacological treatment of many neurological diseases including catamenial epilepsy, stress induced epilepsy, temporal lobe epilepsy, alcohol withdrawal seizures, infantile spasm and status epilepticus. So far, only synthetic neurosteroid, ganaxolone has been tried in treatment of epilepsy and has shown good efficacy and tolerability. But, human data of trials are limited and hence, large double-blinded, placebo-controlled, randomized clinical trials are required before their use. The paper reviews the biosynthesis and GABAA receptor modulation of neurosteroids and their potential role in epilepsy.

Rathke's cleft cyst--an uncommon cause of headache in a young boy.

Developmental disorders of the pituitary can present like a mass lesion in the region of the pituitary and produce pressure effects. Rathke's cleft cyst is one such developmental disorder of the pituitary which presents in early life producing pressure effects namely visual disturbances due to its proximity to optic chiasma, headache, and hormonal imbalance due to pituitary malfunction. In this case report a 19 years boy presented with symptoms of headache and gradual loss of vision over one year period. Neuro-imaging study demonstrated a cystic lesion in the region of the pituitary. Trans-sphenoidal hypophysectomy was performed. Histopathology of the biopsied material was suggestive of Rathke's cleft cyst. Following surgery the boy had a good visual recovery. So early diagnosis and removal of a Rathke's cleft cyst has a good prognosis as compared to a craniopharyngioma which is a very close differential diagnosis.

Gastro-intestinal stromal tumour--a case report.

Gastro-intestinal stromal tumours are a heterogenous group of mesenchymal tumours mostly arising from the stomach and small intestine which may be benign or malignant. A 32-year female presented with abdominal pain and progressive distension of abdomen. On examination liver was enlarged 10 cm below right coastal margin, spleen was also enlarged and non-tender. Shehad marked pallor. On CT scan a hypervascular mass was seen in close relation to the duodenum and is continuous with the lumen of the 2nd part of duodenum. Upper GI scopy showed a proliferative growth in periampullary region with the histopathology of the growth showed features of gastrointestinal stromal tumour. There was no signs of malignant changes. Blood transfusion along with iron and folic acid tablet was the choice of treatment.

Sweet's syndrome preceding carcinoma of the adrenal cortex.

A case of Sweet's syndrome preceding carcinoma of the adrenal cortex is reported. Sweet's syndrome can be a rare premalignant manifestation of carcinoma of adrenal cortex.

An unusual presentation of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disease caused by the damage of tissues and cells by pathogenic auto-antibodies and immune complexes. A 27-year-old female presented with chronic diarrhoea was diagnosed as intestinal tuberculosis. But further evaluation diagnosed it a case of SLE and diarrhoea subsided with treatment. The case is reported because of its atypical presentation.